Certain characteristics predict use of erythropoiesis-stimulating agents (ESA) among patients with nondialysis-dependent chronic kidney disease (NDD-CKD), investigators reported at the virtual National Kidney Foundation 2021 Spring Clinical Meetings.

Efstathios Michalopoulos, PhD, of Otsuka Pharmaceutical in Princeton, New Jersey, and colleagues studied new ESA use among 1,584,851 Medicare patients with NDD-CKD. Mean age was 76.4 years, 57.6% were female, and 76.8% were White. Of the cohort, only 11,335 patients (0.7%) initiated ESA therapy in 2018, including 10,760 (94.9%) diagnosed with anemia. By comparison, 8.0% of patients who did not receive ESAs (125,383 of 1,573,516 patients) also had anemia.

Dr Michalopoulos’ team identified several characteristics associated with greater ESA administration. ESA use was highest in CKD stage 4 (43.3%), stage 3 (27.1%), and stage 5 (26.5%). Patients receiving ESAs were more likely to be seen by nephrologists (47.9% vs 3.1%) followed by hematologists and oncologists (14.2% vs 0.4%) compared with patients not receiving ESAs. Investigators posited that these medical specialties may have more experience with ESAs as well as requisite processes and infrastructure for administration.

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In addition, ESA users were more likely to receive intravenous iron (10.9% vs 0.3%) and laboratory tests for iron (57.7% vs 4.1%), folate (32.0% vs 2.8%), and calcium and phosphorus (64.7% vs 7.2%). With respect to comorbidities, hypertension (78.9%), heart failure (43.0% vs 7.2%), and anemia (92.9% vs 8.0%) were more common among ESA users than nonusers.

“Given the negative consequences of untreated anemia among patients with NDD-CKD, further research may be warranted to elucidate potential barriers to treatment that result in suboptimal treatment rates,” according to Dr Michalopoulos’ team.

They acknowledged that new and future oral anemia treatments, such as hypoxia inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs), can be administered in a wider range of settings and may increase access to treatment.

Disclosure: This clinical trial was supported by Otsuka Pharmaceutical Development and Commercialization, Inc., and Akebia Therapeutics. Please see the original reference for a full list of authors’ disclosures.


Ferro C, Dieguez G, Pareja K, Szabo E, Michalopoulos E. Predictors of ESA use in the non-dialysis dependent chronic kidney disease population with anemia. Presented at the virtual National Kidney Foundation 2021 Spring Clinical Meetings, April 6-10, 2021. Poster 170.